Poster Presentations

Case History: This is a 73 year old lady with known Type 2 Diabetes Mellitus who presented to Acute Medicine with a 2-week history of diarrhoea and acute confusion on a background of a 4-month history of gradual cognitive and functional decline. She was treated for low-respiratory tract infection with acute kidney injury on a background of age-related functional decline. CT brain was organised.Investigations: CT Brain: Large enhancing soft tissue dense l...

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ea0062p02 | Poster Presentations | EU2019

Pituitary hyperplasia due to untreated hypothyroidism

MacKenzie Heather , Imran Syed Ali

Case history: A 51-year old female presented to emergency with occipital headache for 5 days on a background of recurrent headaches for over a year. She had been diagnosed with Hashimotos disease at the age of 30 and given levothyroxine, which she discontinued 5 years ago due to aversion to take medications. She had noticed cold intolerance and low energy. At presentation her body mass index was 25.26 kg/m2 and the physical exam was unremarkable; specifically,...

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ea0062p03 | Poster Presentations | EU2019

Secondary Takotsubo syndrome induced by Phaeochromocytoma

Dhar Mili , Lakshmipathy Kavitha , Poddar Ankur , Field Benjamin , Nayyar Vidhu , Clark James , Zachariah Sunil

Case history: We present the case of a 70-year-old female who presented to the Emergency Department with sudden onset inter-scapular and upper abdominal pain. She had been experiencing intermittent headaches, palpitations and constipation which had not previously been investigated. The only past medical history was of hypothyroidism. She had no significant family history. There was a discrepancy in the blood pressure between both arms. Admission blood pressure was elevated at ...

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ea0062p04 | Poster Presentations | EU2019

Phaeochromocytoma presenting as an adrenal haemorrhage

Dhar Mili , Reid India , Lakshmipathy Kavitha , Poddar Ankur , Field Benjamin , Nayyar Vidhu , Clark James , Zachariah Sunil

Case history: We present the case of a 72-year-old lady who presented to the surgical team with sudden onset abdominal (flank) pain. On initial assessment, she was significantly hypertensive (213/110 mmHg) and tachycardic (pulse 98 bpm) but afebrile. She was not on any anticoagulation. On physical examination, her abdomen was tender with mild guarding and retroperitoneal tenderness.Investigations: Admission blood tests showed a normal haemoglobin (149 g/...

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ea0062p05 | Poster Presentations | EU2019

A rare cause of hyponatraemia

Javaid Usman , Mamoojee Yaasir , Leech Nicola , James Andy

Case history: We describe a case of 35 year old female who presented with abdominal pain, nausea and lower backache. She was initially treated with Trimethoprim for a urinary tract infection. 5 days later, she re-attended hospital with feeling more unwell, ongoing lower abdominal pain and vomiting. On examination, she was haemodynamically stable. She had suprapubic tenderness on abdominal palpation, and the rest of her systemic examination was normal.Inv...

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ea0062p06 | Poster Presentations | EU2019

Unexpected free thyroid hormone results in a case of an incidental pituitary macroadenoma

Samarasinghe Suhaniya , McArthur Sara , Hui Elaine

Case history: We present the case of a 64 year old man with an incidental finding of pituitary macroadenoma (1.1×0.8×0.5 mm). He had a past medical history of obstructive sleep apnoea, asthma, osteoarthritis, hypertension, retinal detachment and cataract.Investigations: Blood tests.Results and treatment: Pituitary function tests showed markedly elevated prolactin 4272 mIU/L (86324), elevated free tri-iodothyronine (...

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ea0062p07 | Poster Presentations | EU2019

Hyperglycemic Diabetic ketoacidosis precipitated by an SGLT-2 inhibitor in a non-insulin dependant type 2 diabetic

Samarasinghe Suhaniya , Tanwani Puja , Kong Wing May

Case history: We present the case of a 51-year-old female of South-East Asian origin presenting with a four-day history of feeling progressively unwell with vomiting, reduced oral intake and urinary symptoms. Her past medical history was T2D (HbA1c 98 mmol/mol March 2018). Drug history on admission was Metformin 500 mg twice daily, Gliclazide 160 mg twice daily, Ramipril 1.25 mg once daily and Dapagliflozin 10 mg once daily. The initiation date of Dapagliflozin and Ramipril co...

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ea0062p08 | Poster Presentations | EU2019

Immunotherapy: the cause or the cure?

Hashim Nazri , Idampitiya Chandi

Case history: A 57 year old man is referred due to repeated admissions with confusion, malaise, hypotension and hyponatraemia. He has a background of metastatic melanoma (brain, liver, lung) for which he had received surgery, whole brain radiotherapy and combined immunotherapy (Ipilimumab and Nivolumab). At the time of referral he was on a maintenance regimen of Nivolumab, the dose of which had been increased just prior to the aforementioned admissions. There was no past medic...

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ea0062p09 | Poster Presentations | EU2019

Chronic diarrhoea - a rare endocrine cause

Pillai Sanesh , Munir Alia , Lorenz Eleanor , Wadsley John

Case history: A 59-year-old male presented to gastroenterology with a two years of high volume persistent watery diarrhoea. He gave a past medical history of poorly controlled, insulin treated diabetes mellitus present for 8 years. He reported abdominal pain and diarrhoea that persisted despite fasting. A colonoscopy with biopsy were reported as normal. Diarrhoea, malaise, fatigue and weight loss persisted.Investigations: Stool culture and faecal elastas...

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ea0062p10 | Poster Presentations | EU2019

Metabolic encephalopathy secondary to diabetic ketoacidosis

Tomkins Maria , Richard McCormack , Karen O'Connell , Agha Amar , Merwick Aine

Case presentation: A 35-year-old man presented to the emergency department (ED) in a confused and agitated state. His past medical history was significant for poorly controlled type 1 diabetes, complicated by background diabetic retinopathy. He was taking basal/bolus insulin and had a history of diabetic ketoacidosis (DKA) eleven years prior. He also had multiple sclerosis however disengaged with neurology services and was non-compliant with interferon therapy. Prior to admiss...

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ea0062p11 | Poster Presentations | EU2019

A rare case of co-existing Thyroid Hormone Resistance and Graves’ disease

Houlford Ben , Sheil Kim , Chong Jimmy

Case history: A 52 year old lady presented to her GP with a 2 year history of headaches, anxiety and loose stools. The GP found lid retraction and fine tremor but no goitre. Her heart rate was 100. Her GP sent blood for thyroid function tests and results showed a TSH of <0.03 mu/l and free T3 of >30.8 pmol/l. She was started on propranolol 40mg thrice daily and referred to endocrinology. In clinic she described palpitations whilst watching TV and sweatiness. She had su...

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ea0062p12 | Poster Presentations | EU2019

Macro-TSH as a cause of spuriously raised TSH in a euthyroid patient

Govindan Rajesh , Crown Anna

Case history: A 28-year-old gentleman was referred with symptoms of memory fog, difficulty with concentration, mood disturbance and fatigue. His thyroid function tests had been stable but abnormal for over 8 years, with a normal FT4 between 1719 pmol/l (1222 pmol/l), FT3 5.6 pmol/l (3.16.8 pmol/l) and an elevated TSH between 1216 mu/l (0.274.2 mu/l). He had no family history of thyroid disease. He was clinically euthyroid. His weight had remained ...

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ea0062p13 | Poster Presentations | EU2019

Extensive intracranial calcification in a patient with hypoparathyroidism

Chok Yin Ling , Larsen Niels , Baburaj Rajee , Narula Kavita

Case history: A 74 years old gentleman with no medical illness presented with loss of consciousness in March 2018. CT head did not show acute cortical infarct but there was florid symmetrical calcification involving the basal ganglia, thalami, cerebellar lobes and subcortical white matter within the parietal-occipital lobes bilaterally. Fahrs disease was suspected and an outpatient MRI was requested.Investigation and Results: 2 weeks later, a routi...

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ea0062p14 | Poster Presentations | EU2019

A case of maternal and fetal virilisation

See Wing Shan

A baby was born at 32 weeks with a birth weight of 1.59 kg. Mother had complex medical history including diabetes mellitus, chronic hypertension, nephropathy, maculopathy, ischaemic stroke on aspirin, hyperthyroidism and polycystic ovarian syndrome. Antenatal scan showed ambiguous genitalia with clitoromegaly and mother had bilateral adnexal multi-separated cysts. Baby was born by emergency lower segment cesaerean section due to pre-clampsia and biopsy of mother adnexal mass w...

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ea0062p15 | Poster Presentations | EU2019

ARDS and life threatening renal failure secondary to severe hypercalcaemia

Millson Victoria

Case history: A 54 year old Polish gentleman was admitted to a large northern teaching hospital, with life threatening hypercalcaemia, requiring renal replacement therapy. He presented with extreme fatigue and lethargy, with a significant reduction in mobility and exercise tolerance. Further initial history was hampered by language barrier and an increasingly moribund patient.Investigations: Base line blood work up revealed stage 3 AKI, with a liver bone...

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ea0062p16 | Poster Presentations | EU2019

Solitary myofibroblastoma of the forearm presenting with ectopic β-human Chorionic Gonadotrophin production.

Rehman Shoib , Dhatariya Ketan

A 57-year-old woman was referred due to elevated urine & serum human chorionic gonadotrophin (β-hCG) concentrations found at routine pre-operative assessment. She was asymptomatic and was not pregnant. Her past history included a long standing benign 7 cm×5 cm myofibroblastic mass in her left forearm asthma, rotator cuff tear and a uterine fibroid. Her medications were cyclical norethisterone, lansoprazole, frusemide & inhalers. The left forearm mass was not ...

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ea0062p17 | Poster Presentations | EU2019

Self-diagnosis of De la Chapelle syndrome

Ahmad Sajjad , Ravindran Ravikumar , Lansdown Andrew

Case history: A 30 years old male Caucasian had his saliva tested on a self-funded commercial DNA testing to identify his ancestral roots. The markers for Y chromosome were found to be absent and further evaluation revealed him to have 46 XX karyotype.This was consistent with the diagnosis of De la Chapelle syndrome or XX male syndrome. Fluorescence in situ hybridization (FISH) studies confirmed the presence of SRY (sex determining region Y) gene which was responsible...

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ea0062p18 | Poster Presentations | EU2019

A rare cause of hypercalcemia and nephrolithiasis

Andrabi Syed Basharat , Kurera Isuri , Maltese Guisseppe , Snape Katie , Bano Gul

We present a 67 years old male originally from Cyprus who presented with Hypercalcemia. He had renal calculi twice and required Laparoscopic procedure. In his family history his 3 siblings had confirmed raised calcium and PTH and 2 other siblings had renal calculi. One of his brother, had surgery for primary hyperparathyroidism twice but no parathyroid adenoma was found and his calcium remained high. Patients calcium was 2.81 mmol/l (2.152.50), 25 HVD 82 nmol/l (75...

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ea0062p19 | Poster Presentations | EU2019

Two novel mutations in the Calcium Sensing Receptor (CASR) gene in patient s with biochemical investigations suggestive of Familial Hypocalciuric Hypercalcemia (FHH)

Samarasinghe Suhaniya , Nogueira Edson , Seechurn Shivshankar

Case history: Case 1: 18-year-old female referred with asymptomatic hypercalcaemia (adjusted calcium 2.69 mmol/l), phosphate 0.96 mmol/l, parathyroid hormone 2.6 pmol/l and total 25 hydroxyvitamin D 37 nmol/l. No evidence of end organ damage. Initial calcium: creatinine clearance ratio 0.0033 but the patient had a vitamin D 24 nmol/l. Case 2: A 53-year-old female referred with asymptomatic incidental hypercalcaemia (adjusted calcium 2.732.87 mmol/l), raised parathyroid h...

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ea0062p20 | Poster Presentations | EU2019

Hypercalcemia in pregnancy in a patient with previous miscarriages

Arfan Rabia , Mohammadi Alireza , Akavarapu Sriranganath , Sam Amir , Meeran Kareem

Case history: 36 years old, 14 weeks pregnant lady was referred to endocrinology department by GP urgently with corrected Calcium CCa of 2.97 mmol/l and normal parathyroid hormone (PTH). Her symptoms were urinary frequency and nausea. She had 3 previous miscarriages and 2 normal births. She was on folic acid and vitamin D supplements. There was family history of type 2 diabetes and B12 deficiency. Her 6 family members had normal calcium levels.Investigat...

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ea0062p21 | Poster Presentations | EU2019

An atypical presentation of subclinical spontaneous pituitary apoplexy

Samarasinghe Suhaniya , Kaushal Rashmi , Qureshi Sheharyar A

Case history: A 34-year-old man attended the emergency department with a history of sudden onset severe headache associated with vomiting, neck stiffness mild photophobia not relieved with analgesia. He reported a past medical history of hypertension treated with angiotensin-converting enzyme inhibitor (ACEi). There was no focal neurology, and his observations were unremarkable - blood pressure 121/64 mmHg, heart rate 54 beats per minute, respiratory rate 14 breaths per minute...

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ea0062p22 | Poster Presentations | EU2019

A rare variant of Hashimoto’s thyroiditis

Eid Hatem , Andrabi Basharat , Kurera I , Bano G

Hashimotos thyroiditis (HT) is the most common inflammatory condition of the thyroid gland. In addition to the classic variant of HT, several other subtypes have been identified, such as the fibrous variant (HTFV).Case history: A 38 years old man noticed a rapidly enlarging lump in his neck month ago. This resulted in discomfort with choking sensation and mild dysphagia. He mentioned weight loss, tiredness and night sweats. He was a smoker and dran...

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ea0062p23 | Poster Presentations | EU2019

Pancreatic lesions in von Hippel–Lindau (vHL) disease: A diagnostic and management challenges

Kurera I , Andrabi B , Ismail R , Snape K , Bano G

vHL disease is commonly inherited in an autosomal dominant fashion. Pancreatic lesions in vHL are generally asymptomatic or associated with mild nonspecific symptoms.Case history: A 40 year old Asian female was seen in genetic/endocrine clinic for Predictive vHL mutation. She was married to her first cousin and had a 19 years old daughter. Her sister was diagnosed with vHL in Canada. She presented with Renal cell carcinoma and renal cysts. Her mother die...

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ea0062p24 | Poster Presentations | EU2019

First paraganglioma identified on surveillance screening in an asymptomatic SDHA germline mutation carrier

White Gemma , Tufton Nicola , Adams Ashok , Akker Scott

Case history: We present the case of a 72-year-old female who was referred to the endocrinology service following the identification of a pathogenic germline mutation in the SDHA gene (c.91C>T, p.Arg32*) as part of a genetic panel for hypertrophic cardiomyopathy. There was no personal or family history of phaeochromocytoma or paraganglioma (PPGL), gastrointestinal stromal tumours or pituitary adenoma.Investigations: Our patient was reviewed ...

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ea0062p25 | Poster Presentations | EU2019

Elevation in free T3 following levothyroxine treatment – the clue to a diagnostic challenge

Burton Felicity , Dimitri Paul

Case History: We present a 3-week-old baby who presented to a District General Hospital with prolonged unconjugated hyperbilirubinaemia and evolving developmental delay.Investigations: Initial thyroid function demonstrated a TSH at 2.41 mIU/l (0.8-5.4), free T3 at 7.39 pmol/l (3.407.60) and free T4 at 9.9 pmol/l (11.023.6). The TFT was repeated using an alternative assay with FT4 at 11.8 pmol/l (11.528.3), FT3 at 9.20 pmol/l (3.00...

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ea0062p26 | Poster Presentations | EU2019

A rare case of dual cerebral venous sinus thrombosis secondary to Thyroid storm

Khine Win , MacFarlane James , Lee Martin , Rice Katy , Swe Myint Khin

Background: Evidence suggested a hypercoagulable state in the context of hyperthyroidism. We presented a case of cerebral venous thrombosis (CVT), a rare but potentially fatal complication of the already high mortality thyroid storm.Case History: A 16year old boy with Aspergers syndrome was admitted with one-month history of non-specific illness and weight loss followed by 2 weeks of progressive frontal headaches and vomiting, weakness in left arm ...

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ea0062p27 | Poster Presentations | EU2019

A rare cause of human acidosis: lessons from the milking shed

O'Toole Sam , Ruprai Leanna , Tern Paul , Doshi Akash , Hansi Navjyot , Corbishley Alex

Case history: A 27-year-old woman presented with a 48 hour history of lethargy, nausea and myalgia. Twelve days earlier she had given birth to her first child. Her daughter was born at term following an uncomplicated pregnancy. She had no abdominal pain or vaginal discharge and her episiotomy wound was well healed. She had no significant past medical history, took no regular medications and did not drink alcohol. There was no significant family history. On arrival in the emerg...

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ea0062p28 | Poster Presentations | EU2019

Alemtuzumab induced thyrotoxicosis in a patient undergoing autologous haematopoietic stem cell transplant for multiple sclerosis

Esdaile Harriet , Hinton Richard , Sheridan Helena , Rogosic Srdan , Pavlu Jiri , Olavarria Eduardo , Gabriel Ian

Case History: A 37 year old female underwent an elective autologous stem cell transplant (ASCT) for multiple sclerosis (MS), with cyclophosphamide and anti-thymocyte (ATG) conditioning. She had previously received two doses of alemtuzumab, with the last dose 12 months prior to ASCT. Baseline thyroid function was normal pre atemluzumab. 3 months prior to dose 2 (18 months post first dose), subclinical hyperthryoidism was present with a raised TSH antibody (0.08 unit/ml). There ...

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ea0062p29 | Poster Presentations | EU2019

Normotensive primary hyperaldosteronism as a prelude to atrial fibrillation: potentially curable by endoscopic radiofrequency ablation?

Wu Xilin , Ney Alexander , Cheow Heok , Drake William , Pereira Stephen P , Brown Morris

Case History: In 2011, an asymptomatic 63-year-old professor was found to have isolated hypokalemia. He was normotensive and his only past medical history was hypercholesterolaemia. Investigations were suggestive of Primary Hyperaldosteronism (PHA): aldosterone 1055 pmol/L, renin mass 10 mU/L, Na+137 mmol/L, K+3.2 mmol/L, bicarbonate 31 mmol/L. A CT scan was reported as normal, but a 12mm nodule was subsequently noted contiguous with the left adrenal. A m...

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ea0062p30 | Poster Presentations | EU2019

A dangerous master of disguise – An undiagnosed phaeochromocytoma presenting with pulmonary haemorrhage

Anandappa Samantha , Bakhit Mohamed , Diaz-Cano Salvador , Lewis Dylan , Ogunko Arthur , Whitelaw Benjamin

Case history: A 39 year old female had a first admission to her local hospital with cough and haemoptysis. She reported palpitations for the previous 6 months and had been previously investigated with an echocardiogram which showed a normal LV function. There was no other past medical history. During this first admission CT Pulmonary Angiogram (CTPA) demonstrated ground-glass opacifications. She was hypertensive and so a 24 hour urine sample was collected for metanephrines but...

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ea0062p31 | Poster Presentations | EU2019

Hypercalcemia: a diagnostic challenge

Khan Amber , Kaushal Kalpana

A 44 year old man attended our endoscopy unit for gastroscopy to further investigate ongoing epigastric pain. He was incidentally found to be very hypertensive so gastroscopy was cancelled. Hypertension was treated. He had past medical history of hypertension and Gout. Routein blood tests showed renal impairment with significantly raised calcium 3.19 mmol/l. Hypercalcemia was treated with iv bisphosphonates. MEN 2a, was considered as a unifying diagnosis for high calcium and h...

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ea0062p32 | Poster Presentations | EU2019

Pan-hypopituitarism induced by additive effect of cranial radiotherapy (CRT) and Nivolumab

McFiggans Emily , Gore Martin , Morganstein Daniel

Case history: A patient with malignant melanoma with multiple cerebral metastases and a left adrenal metastasis was treated with CRT (30Gy, 10 fractions). This was followed by 12 cycles of Nivolumab, after which the left adrenal lesion was managed with cyberknife (30Gy, three fractions) and Nivolumab was continued thereafter. The patient developed worsening deafness, became unsteady on his feet and complained of feeling generally unwell. At this time an MRI brain was performed...

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ea0062p33 | Poster Presentations | EU2019

A case of thyrotoxic periodic paralysis

Sim Sing Yee , Pierides Michael , Patel Kishor , Mani Hamidreza

Case history: Thyrotoxic periodic paralysis (TPP) which was first described in 1902 is characterised by episodes of painless muscle weakness, hypokalaemia and thyrotoxicosis without any total body potassium deficit. It predominantly affects people of Asian descent between 20 and 40 years old with a 2 percent incidence compared to 0.2 percent in non-Asian descent. The pathogenesis of TPP is related to an increase Na+/K+-ATPase activity in the skeletal muscle leading to an influ...

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ea0062p34 | Poster Presentations | EU2019

A case of ‘Camouflaged Insulinoma & Diazoxide quandary’

Aneela Irrum , Tshering Sonam , Aman Mansoor , Khan Irfan

Case history: A 74 years old lady with background of hypertension and asthma had multiple admissions with funny turns, dizziness and double vision for at least 2 years. She was seen by various medical specialties including cardiology, stroke medicine and rheumatology before she was noticed to have a capillary glucose of 1.2 mmol/l. Whipples triad was demonstrated during evaluation. Supervised fasting confirmed biochemical evidence of endogenous hyperinsulinaemia with ina...

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ea0062p35 | Poster Presentations | EU2019

Abstract Unavailable....

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ea0062p36 | Poster Presentations | EU2019

A case of meningioma associated with long-term use of cyproterone acetate

Owens Lisa , Halliday Jane , Kerr Richard , Franks Stephen

Case history: A 58 year old woman presented to her GP when her family members noted prominence of her left eye. She had a background history of polycystic ovary syndrome (PCOS). Her main symptom of PCOS was hirsutism. She had been treated initially with the combined oral contraceptive pill Dianette (ethinyloestradiol/cyproterone) but had also been treated intermittently with varying doses of 25100 mg cyproterone acetate (CPA) 10 days/cycle. Post menopause she...

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ea0062p37 | Poster Presentations | EU2019

A unique case of Graves’ disease and Low Platelets

Naeem Ammara , Garg Anukul , Aung Htet Htet

Case history: A 38 years old Afro-Caribbean gentleman presented in June 2018 with symptoms of hyperthyroidism. He is a smoker and takes alcohol occasionally. Examination revealed fine tremors, tachycardia, moderate sized goitre with no thyroid bruit and right sided proptosis. Thyroid workup revealed suppressed TSH, raised free T4 and TRAb of 9.75 IU/L suggesting Graves Thyrotoxicosis. He was started on 20 mg of Carbimazole (CBZ)OD with Propanolol. After initiating carbim...

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ea0062p38 | Poster Presentations | EU2019

Genetic sequelae of a thyroidectomy

Jiwan Riyah , Sherpa Gina , Noronha Sean , Ali Asif

Case history: A 28-year-old female was investigated for hypocalcaemia. Her calcium level was checked because her mother was found to be hypocalcaemic post thyroidectomy for recurrence of Graves disease. Further detailed history taking revealed that the patients grandmother often complained of hand cramps on kneading dough. The patients aunt was believed to have a parathyroid disorder; no further details were available. On further investigation, it was apparent that...

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ea0062p39 | Poster Presentations | EU2019

Hypophysitis secondary to pembrolizumab use in primary lung carcinoma with brain and adrenal metastasis: An evaluation of hormone replacement and future management

Khanam Amina , Mitchell Antonine Pineau , Khan Madeha , Charles Debbie-Ann , Tremble Jennifer

Case history: A 72 year old male was diagnosed with primary lung adenocarcinoma grade T4N2M1b with adrenal and brain metastasis 1 year previously. On diagnosis his tumour was strongly positive for PDL-1 expression. This patient was started on dexamethasone 8 mg once a day that was weaned down to 4mg twice daily and then slowly weaned off steroids whilst receiving whole brain radiation. He was started on pembrolizumab therapy and had received ten cycles of treatment when he beg...

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ea0062p40 | Poster Presentations | EU2019

Hypopituitarism and hyperprolactinemia secondary to a sella/suprasellar mass consistent with metastatic lung adenocarcinoma

Mitchell Antonine Pineau , Khanam Amina , Charles Debbie-Ann , Tremble Jennifer

Case history: A 68 year old woman was referred to Endocrinology with a history of vomiting, extreme fatigue of acute onset and non-specific visual changes. She had a history of primary hypothyroidism and an adenocarcinoma of the lung with bone metastases initially been treated with pemetrexed and cisplatin chemotherapy. The patient subsequently required palliative radiotherapy for metastatic spinal cord compression and was started on denosumab. Imaging shortly before her refer...

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ea0062p41 | Poster Presentations | EU2019

An Interesting case of Transient Graves’ Ophthalmopathy on the background of Hashimoto’s Thyroiditis

Zaman Shamaila , Behary Preeshila , Khalid Neelam , Todd Jeannie

Case History: A 30 year old woman presented with the history of swollen painful eyes for 4 weeks while visiting Italy. She had a background of Hashimotos Thyroiditis since 2010 and was treated with levothyroxine 100 mcg once daily. She was given a course of oral steroids for 2 weeks and her thyroxine dose was reduced to 25 mcg once daily in Italy. Since then, her orbital swelling began to improve. She was a non-smoker. On examination, she was noted to have bilateral mild...

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ea0062p42 | Poster Presentations | EU2019

Severe hypercalcaemia in a young patient

Lin NT , Thomas M

Case History: 16-year-old fit and well lady was referred to endocrinology clinic by GP due to severe hypercalcaemia. She is being investigated for secondary amenorrhea. She is not taking any regular medication. There is a history of hypercalcaemia in the family, her mother has hypercalcaemia and paternal grandfather had hypercalcaemia. She had no signs and symptoms of hypercalcaemia.Investigations: Corrected Calcium: 3.28 mmol/l, Phosphate: 0.60 mmol/l, ...

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ea0062p43 | Poster Presentations | EU2019

Thyroid storm - from clinic to intensive care

Chortis Vasileios , Hazlehurst Jonathan , Boelaert Kristien

Case history: A 46-year-old female patient presented to A&E with a three day history of diarrhoea and vomiting, after three months of progressive weight loss. Her past medical history included chronic autoimmune thrombocytopaenia and Graves disease, which had been diagnosed four years earlier and treated with a brief course of propylthyuracil (PTU). She was clinically in extremis, with signs of severe cardiovascular and respiratory compromise and reduced res...

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ea0062p44 | Poster Presentations | EU2019

Pituitary metastasis masquerading as a non-functioning pituitary macroadenoma

Sheikh Anum , Zac-Vargheses Sagen , Joharatnam Jalini

Case History: A female, aged eighty-three was admitted for an elective urology stent procedure. She had a background history of a non-functioning pituitary adenoma diagnosed 3 weeks before admission. This was found after investigation for headache and diplopia. The pituitary lesion was described as 18 × 17 × 14 mm in size and mixed solid/cystic in nature. There was no chiasmal compression. During that admission her case was discussed with neurosurgery and it was felt...

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ea0062p45 | Poster Presentations | EU2019

Delivery of a diagnosis

Mathew SV , Mumby C

Case history: A 32 female was referred to a tertiary maternity unit due to hypercalcaemia and a diagnosis of primary hyperparathyroidism (PHPT). She had learning difficulties, 2 previous C-sections and was a smoker. She presented 5 years earlier to her local hospital with abdominal and leg pains, nausea, constipation and fatigue. She had undergone 2 parathyroidectomies but remained hypercalcaemic and had been managed medically with Cinacalcet when she conceived an unplanned pr...

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ea0062p46 | Poster Presentations | EU2019

Thyroid Dysfunction induced by Alemtuzumab; a monoclonal antibody used in the treatment of multiple sclerosis

Hamill Connor , Courtney Hamish , Lewis Anthony

Case History: Case 1: A 37-year-old lady with relapsing-remitting multiple sclerosis was initiated on Alemtuzumab and symptoms of sweats and heat intolerance arose. Hyperthyroidism was confirmed with free T4 30.1 pmol/l (1222) and suppressed TSH. Symptoms settled without antithyroid medication and within 2 months T4 had fallen to 10.2 pmol/l with TSH 6.95 mIU/L. After a further 6 weeks T4 was 9.8 with TSH 20.35 and levothyroxine was initiated. Anti-TPO was raised at 442 ...

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ea0062p47 | Poster Presentations | EU2019

Two cases of ectopic ACTH in advanced NETs

Priest Josephine , Kok Kimberly , Wren Alison , Watkins David , Morganstein Daniel

Case history: Patient 1, a 78 year old male, was diagnosed five years ago with a metastatic NET with octreotide avid disease including ileocolic/right common iliac nodal metastases and a solitary segment VII liver lesion. He elected for watchful waiting and was asymptomatic. Interval imaging showed gradual local disease progression. He was diagnosed with motor neurone disease resulting in unilateral arm weakness. He re-presented four years after diagnosis with progressive weak...

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ea0062p48 | Poster Presentations | EU2019

Partial cranial diabetes insipidus in breast cancer: invisible pituitary metastases or uncanny coincidence

Westall Sam , Sullivan Heather , McNulty Sid , Bujawansa Sumudu , Narayanan Prakash

Case history: PD is a 57-year-old female teacher who presented to her GP in October 2017 with lethargy, dyspnoea and anaemia. Bone marrow biopsy followed by a CT scan of her chest and abdomen confirmed lobular breast cancer with peritoneal and bone metastases (ER+/HER2−). The patient also had an MRI scan of her head to assess for intracranial metastatic disease which was negative at the start of December 2017. She was commenced on letrozole, palbociclib and denosumab. A ...

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ea0062p49 | Poster Presentations | EU2019

A challenging case of transient hypercortisolism presenting with diabetic ketoacidosis: could this be cyclical Cushing’s syndrome?

Nogueira Edson , Samarasinghe Suhaniya , Qureshi Asjid , Seechurn Shivshankar

A 49-year-old female was admitted to with diabetic ketoacidosis (DKA) and newly diagnosed diabetes. Her only significant medical problem was malignant hypertension with poorly controlled blood pressure (BP) on four antihypertensive agents. She reported no exogenous glucocorticoid or liquorice ingestion. She also complained of a 6-month history of lethargy, weight gain, and a two-month history of easy bruising, lower-limb weakness, increasing polyuria and polydipsia. There was ...

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ea0062p50 | Poster Presentations | EU2019

Nature’s price for Cushing’s disease: A blind eye and a hole in the (pituitary) Middle

Sullivan Heather , Westall Sam , McNulty Sid , Furlong Niall , Gilkes Catherine , Daousi Christina , Narayanan Prakash

Case history: A 61 year old male with a background of diabetes mellitus Type 2 and congestive cardiac failure (CCF) was diagnosed with Cushings disease in 2014 following identification of severe osteoporosis through investigations for non-traumatic vertebral fractures causing paraplegia.Investigations: He had high ACTH and cortisol levels which failed to suppress on low and high dose dexamethasone suppression tests, hypogonadotrophic hypogonadism a...

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ea0062p51 | Poster Presentations | EU2019

Steroid cell ovarian tumour presenting with severe hyperandrogenism

Rehman Shoib Ur , Brennan Sinead , Swords Francesca

A 69-year-old woman was referred with a 2 year history of frontal balding, deepening voice and weight loss. Past medical history included primary hypothyroidism, osteoarthritis, varicose veins and menopause at age of 50 years. Current medications included levothyroxine. She was otherwise very well and enjoyed heightened physical endurance regularly cycling >60 miles with a group of male friends. On examination she was virilised with male pattern alopecia, marked fac...

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ea0062p52 | Poster Presentations | EU2019

A rare case of pituitary extraventricular neurocytoma presenting with visual field defects

Naseem A , Khan I , Kochhar R , Robinson A , Mukherjee A , Kearney T

Case report: Central neurocytomas are well-differentiated rare central nervous system tumours. These tumours when identified in brain parenchyma or spinal cord are termed as extra ventricular neurocytomas. We report a case of 40 year old lady with mild hypertension who presented with long standing history of intermittent headaches which got worse 2 months before presentation, mainly affecting her forehead and left retro-orbital region. She also noted blurring of vision in her ...

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ea0062p53 | Poster Presentations | EU2019

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ea0062p54 | Poster Presentations | EU2019

Iatrogenic euglycaemic DKA following polypharmacy overdose

McKeag Conor , McDermott Michael

Case history: A 39 year old male patient presented via ambulance to our unit with a deliberate mixed overdose. He had a past medical history of type 2 diabetes mellitus, depression and hypertension. He had ingested an uknown amount of atenolol, dapagliflozin, ramipril, co-codamol with both cocaine and benzodiazepines detected in urine toxicology. On arrival to hospital, the patient had fluid refractory hypotension, with a systolic blood pressure of 70mmHg and HR 45BPM. Given t...

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ea0062p55 | Poster Presentations | EU2019

Ectopic insulin production complicating pancreatic neuroendocrine tumour (pNET)

Carmichael Juliet , Starling Naureen , Shotliff Kevin , Morganstein Daniel

Case history: 58 year old male presented in April 2016 with haematemesis. Octreotide-avid pancreatic mass with liver metastases was identified. Liver biopsy demonstrated well differentiated Grade 2 NET (Ki-67 1013%). He progressed on Somatostatin analogue therapy, and subsequently Sunitinib, following which he underwent four cycles of Peptide Receptor Radionuclide Therapy (PRRT) with partial response. In May 2018, there was radiological progression. He reported episodes ...

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ea0062p56 | Poster Presentations | EU2019

Paraganglioma of the seminal vesicle

Ravindran Ravikumar , Witczak Justyna , Lansdown Andrew , Premawardhana LDKE

Case history: A 49-year-old male with hypertension (on doxazosin, amlodipine and perindopril), obesity (BMI 40 kg/m2) and recent DVT (on warfarin) presented with a few months history of episodic headaches, palpitations, light-headedness and sweats accompanied by facial pallor, occurring around twice weekly without warning. Symptoms were often worse when upright. Spontaneous recovery followed. He did not have a family history of endocrine disease. Clinical exam...

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ea0062p57 | Poster Presentations | EU2019

Alirocumab and the management of dyslipidaemia associated acute pancreatitis

Sharma A , Wadhwani R , Macmaster D , Vakilgilani T

Case history: A 59-year-old lady with a background of type 2 diabetes, hypercholesterolemia and hypertension presented with a 3-week history of progressively worsening central abdominal pain and vomiting. Her drug history included bezafibrate and atorvastatin on which she was unable to meet her cholesterol and lipid targets and hence were stopped two weeks prior to her admission. The plan had been to start once fortnightly Alirocumab, a PCSK9 inhibitor; which had been delayed ...

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ea0062p58 | Poster Presentations | EU2019

In a bind: abnormal thyroid function tests

Hilton Catriona , Ahmed Farhan , Ali Asif

Case history: A 44 year old black African woman was referred to the endocrinology clinic for investigation of abnormal thyroid function tests. She had initially presented with palpitations and sweats. She had no significant past medical history and was not taking any prescribed medications or over the counter preparations. On examination, she was clinically euthyroid and did not have any abnormal findings of note.Investigations: Biochemical investigation...

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ea0062p59 | Poster Presentations | EU2019

Treatment of low bone density with a thiazide-like diuretic in idiopathic hypercalciuria

Almazrouei Raya , Comninos Alex , Cox Jeremy

Case History: A 64 year old lady with osteoporosis was referred for parental antiresorptive therapy due to a history of oral bisphosphonate intolerance. She was screened for osteoporosis at age 53 after her mother suffered a hip fracture, DEXA showing an L2-L4 T score of −2.5 and mean femur −2.2. She was given a trial of alendronate, but stopped due to indigestion. On Calcium and Vitamin D supplementation, the DEXA after 4 years showed improvement of both the spine...

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ea0062p60 | Poster Presentations | EU2019

Hypophosphatemic osteomalacia due to Fanconi’s syndrome in a patient with HIV and Hepatitis B coinfection

Siddiqui Mohsin , Rayment Michael , Kilbride Hannah , Gor Ratan , Shotliff Kevin , Dede Anastasia

Case history: A 56 year old man presented with a few months history of diffuse bone pain affecting his arms, legs, ribs and particularly his left hip. Past medical history included well controlled HIV infection, hepatitis B co-infection, peripheral neuropathy associated with HAART, lipoatrophy, Kaposis sarcoma, ADHD, type 2 diabetes mellitus, and a history of previous Fanconis syndrome associated with Tenofovir Disoproxil Fumarate (TDF) 8 years ago. At his initial ...

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ea0062p61 | Poster Presentations | EU2019

A challenging case of cerebral salt wasting syndrome superimposed on central diabetes insipidus following pituitary tumour apoplexy

Mitchell Kirsten , Lamb Carly , Demssie Yared

Case history: An 84-year old man with known non-functioning pituitary macroadenoma was admitted with productive cough and headache. Clinical assessment revealed evidence of pneumonia and antibiotic treatment was initiated. However subsequently the patients GCS dropped to 12. Left-sided 6th nerve palsy was present, but patient drowsiness precluded visual-field examination. CT brain showed pituitary tumour apoplexy due to haemorrhage, confirmed on MRI. His condi...

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ea0062p62 | Poster Presentations | EU2019

A case of a TSH-secreting pituitary macroadenoma in a previously well thirty year old woman

Golding Jonathan , Canagon Sara , Norris John , Chakera Ali

Case History: A thirty year old female presented to hospital after a first seizure. She had no significant past medical history. She had a one week history of recurrent frontal headaches and had noticed irregular periods. There were no clinical features of acromegaly. CT and MRI brain imaging showed a 5 cm mass arising from the pituitary fossa, extending into the suprasellar cistern and anterior cranial fossa. There was evidence of mass effect on the optic nerves and optic chi...

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ea0062p63 | Poster Presentations | EU2019

Prednisolone replacement makes steroid optimisation easier in patients on mitotane

Almazrouei Raya , Meeran Karim , Wernig Florian

Case history: A 66 year old lady presented with abdominal pain, new onset diabetes and hypertension. She was diagnosed with Cushings syndrome and was found to have a large heterogeneous left adrenal mass of 11.4 × 9.3 cm in size with no disease elsewhere. She underwent a left open adrenalectomy and the histology confirmed an adrenocortical carcinoma (Weiss score of 7) with focal vascular invasion, no extra-capsular spread and clear resection margins. Following surge...

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ea0062p64 | Poster Presentations | EU2019

5-year survival in poor prognosis adrenocortical carcinoma without mitotane treatment

Kok Kimberly , Gertrude Priest Josephine , Morganstein Daniel , Wren Alison

Case history: 52 year old gentleman presented in 2013 with a 1 year history of abdominal pain. Imaging to screen for gallstones identified a large adrenal mass which was radiologically suspicious for adrenal carcinoma with probable inferior vena cava (IVC) involvement.Investigations: Overnight dexamethasone suppression test (ONDST) failed to suppress cortisol (324 nmol/l) with undetectable ACTH (<5 ng/l). Failure of suppression on low dose dexamethas...

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ea0062p65 | Poster Presentations | EU2019

Pituitary abscess with meningitis: a rare presentation

Kochhar Rupinder , Naseem Asma , Kearney Tara

Case history: A 42-year-old lady was referred from neurology clinic after being assessed for symptoms of headaches, dizziness, transient visual problems and paraesthesia over her limbs for 2 months. On review, she complained of amenorrhoea and was noted to be pale, however, her neurological examination including visual fields to confrontation and ocular movements were normal. Subsequent investigations were consistent with pan-hypopituitarism and she was promptly commenced on h...

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ea0062p66 | Poster Presentations | EU2019

Treatment of low bone density with a thiazide-like diuretic in idiopathic hypercalciuria

Almazrouei Raya , Comninos Alexander , Cox Jeremy

Case History: A 64 year old lady was referred for parental antiresorptive therapy due to a history of oral bisphosphonate intolerance. She had been screened for osteoporosis at age 53 after her mother had suffered a hip fracture, DEXA scan showed an L2-L4 T score of −2.5 and a mean femur −2.2. She was given a trial of alendronate, but had stopped due to indigestion. The DEXA scan at 4 years showed improvement of both the spine and femur densities on Calcium and Vit...

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ea0062p67 | Poster Presentations | EU2019

Adrenal insufficiency and iatrogenic Cushing’s syndrome in an asthmatic patient on inhaled corticosteroids and antidepressants

Mamdani Jena , Tao Steven , Chatharoo Sarah

Case history: A 45-year-old female with a background of depression presented with asthma exacerbation. She was taking paroxetine and mirtazapine for depression. Over the preceding six months the patients asthma control had deteriorated, resulting in overuse of inhaled beclometasone. On questioning, the patient reported a four stone weight gain in four months with generalised weakness, dizziness and fatigue during simple activities. On examination, the patient appeared ov...

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ea0062p68 | Poster Presentations | EU2019

The double edge sword steroid facilitated diagnosis of primary thyroid lymphoma

Ali Mudassir , Pervez Muhammed , Mounter Philip , Shanker Vivek , Kamaruddin Shafie

Introduction: Primary thyroid lymphoma (PTL) is a rare cause of malignancy, accounting for <5% of thyroid malignancies and < 2% of extra-nodal lymphomas. Most thyroid lymphomas are non-Hodgkins lymphomas of B-cell origin. Patients with Hashimotos thyroiditis are at greater risk for developing PTL. Early diagnosis is important as treatment and prognosis of PTL depend upon the histology and stage of the tumour at diagnosis. We report a rare case of primary th...

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ea0062p69 | Poster Presentations | EU2019

It’s not all primary hypertension

Papanikolaou Nikoleta , Yunus Ajmal

Case history: 48 year old man presented in the endocrinology clinic for further evaluation of hypertension (HTN). He had a hospital admission 2 months ago with worsening dyspnoea and markedly elevated BP (236/149 mmHg). He denied any visual disturbances or chest pain. There were no symptoms to suggest any endocrinopathy. His PMH included previous inguinal hernia repair. He was not on regular medications and he had no allergies. He lived with his family, worked as a manager and...

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ea0062p70 | Poster Presentations | EU2019

How low can you go? Isolated hypothyroxinaemia in pregnancy

Scott Rebecca , Jarvis Sheba , Frise Charlotte

Case history: A 40-year-old, primaparous woman was referred at 24 weeks gestation to Obstetric Medicine for review of abnormal thyroid function tests (TFTs).Investigations: One year prior to pregnancy, TFTs included a thyroid stimulating hormone (TSH) level of 0.95 mU/l (local non-pregnant reference range 0.34.2 mU/l) and a free thyroxine level (fT4) of 7.3 mU/l (local non-pregnant reference range 9.023.0 mU/l). At 18 weeks gestat...

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ea0062p71 | Poster Presentations | EU2019

Late effects of cancer treatment: it’s not always the pituitary

Banu Zeenat , Grandage Victoria , Simpson Helen

A 21 years old male, diagnosed with ALL in 2003 (aged 9), completed treatment in June 2009 (aged 15). Chemotherapeutic agents included doxorubicin, daunorubicin, cytarabine, mercaptopurine, methotrexate, asparaginase, vincristine, dexamethasone (7 mg for 3.5 years). He didnt receive any cranial irradiation. He underwent endocrine assessment aged 15 because of delayed puberty and had testosterone replacement for 4 years (September 2012 till January 2016). He also had hist...

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ea0062p72 | Poster Presentations | EU2019

Challenges in managing a young lady with recurrent unexplained hypoglycaemia

Robbins Tim , Murthy Narasimha , Gholap Nitin

Case history: A 23-year-old Caucasian nurse presented with six months of frequent recurrent symptomatic hypoglycaemic episodes with capillary blood glucose ranging between 1.2 and 3.5 mmol/l and symptoms improving after a carbohydrate snack or a drink. The episodes were more likely to occur during fasting state and after excess physical activities. A careful history excluded intake of any off-prescription medications, dfrugs or psychosocial problem.Inves...

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ea0062p73 | Poster Presentations | EU2019

A curious case of hypernatraemia

Storey L , Fox A , Edmondson J , Maney A , Cross H , Rahi R , Deans J

This case pertains to a 58 year old female who attended hospital with right leg pain. Past medical history included metastatic uterine cancer (lung, bone, and brain), and bipolar disorder treated with sodium valproate and lithium. Prior to admission the patient lived at home with her husband, mobilised independently, and communicated with a mild expressive dysphasia secondary to brain metastases. The patient was admitted under orthopaedics and diagnosed with a pathological rig...

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Society for Endocrinology Endocrine Update 2019

BiosciAbstracts